Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients
Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients
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DOI：
10.7326/0003-4819-143-11-200512060-00008
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发表时间：
2005-12-06
影响因子：
39.2
通讯作者：
Burton, JR
中科院分区：
文献类型：
--
作者：
Leff, B;Burton, L;Burton, JR
背景：患有急症的老年人在急症护理医院接受护理时经常会经历不良事件。目的：评估在家中医院为患者提供医院级急症护理的临床可行性和有效性。设计：前瞻性准实验。地点：2 个地点的 3 个医疗保险管理的护理（医疗保险 + 选择）卫生系统和退伍军人管理局医疗中心。参与者：455 名社区居住的老年患者，他们因社区获得性肺炎、慢性心力衰竭恶化、慢性阻塞性肺病恶化或蜂窝织炎而需要入住急症护理医院。干预：以医院家庭护理模式治疗，替代急症护理医院的治疗。测量：临床过程测量、护理标准、临床并发症、护理满意度、功能状态和护理费用。干预：以医院家庭护理模式进行治疗，替代急症护理医院的治疗。测量：临床过程测量、护理标准、临床并发症、护理满意度、功能状态和护理费用。结果：家庭医院护理在为在家患者提供医院级护理方面是可行且有效的。在所研究的 3 个地点中的 2 个中，69% 接受家庭医院护理的患者选择了家庭医院护理，而不是急性医院护理；在第三个地点，29%的患者选择了医院居家护理。尽管与急症医院护理相比，程序性较差，但家庭医院护理达到的质量标准与急症医院护理相似。在意向治疗的基础上，在家医院接受治疗的患者的住院时间较短（3.2 天与 4.9 天）（P = 0.004），并且有证据表明他们的并发症也较少。家庭医院护理的平均成本低于急性医院护理的平均成本（5081 美元 vs. 7480 美元）（P < 0.001）。局限性：由于准实验设计和缺失数据、样本量较小以及研究地点差异，可能存在选择偏差。结论：家庭医院护理模式对于某些患有特定急性内科疾病、需要紧急医院级护理的老年患者来说是可行、安全和有效的。
Background: Acutely ill older persons often experience adverse events when cared for in the acute care hospital.Objective: To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home.Design: Prospective quasi-experiment. Setting: 3 medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center.Participants: 455 community-dwelling elderly patients who required admission to an acute care hospital for community-cquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.Intervention: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital. Measurements: Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care.Intervention: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital.Measurements: Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care.Results: Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality standards at rates similar to those of acute hospital care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs. 4.9 days) (P = 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care ($5081 vs. $7480) (P < 0.001). Limitations: Possible selection bias because of the quasi-experimental design and missing data, modest sample size, and study site differences.Conclusions: The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.